發(fā)布時(shí)間：2018-03-05 16:30

  本文選題：創(chuàng)傷　切入點(diǎn)：出院意愿　出處：《中南大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討醫(yī)保創(chuàng)傷患者的心理狀況,并分析影響其出院意愿的因素,為提高患者出院依從及減少衛(wèi)生服務(wù)的過度利用提供相關(guān)理論支持,以便減少過度衛(wèi)生資源浪費(fèi),更好地完善全民醫(yī)保。 方法首先根據(jù)研究主題與研究內(nèi)容進(jìn)行廣泛的文獻(xiàn)檢索與細(xì)讀,通過文獻(xiàn)梳理與數(shù)據(jù)整理對(duì)目前的已有的創(chuàng)傷患者心理健康及患者出院意愿等相關(guān)文獻(xiàn)有初步了解同時(shí)進(jìn)行總體描述,除了進(jìn)行概念與理論上的梳理外,還重視實(shí)證調(diào)查的方法,通過采用結(jié)構(gòu)性問卷和觀察法對(duì)中南大學(xué)湘雅三醫(yī)院及湖南湘雅博愛康復(fù)醫(yī)院外科科室的136例創(chuàng)傷患者進(jìn)行調(diào)查與定性訪談以采集信息資料,問卷包括基本資料、心理健康狀況自評(píng)量表(SCL-90)、自尊量表(SES)、社交回避及焦慮量表(SAD)、艾森克人格個(gè)性問卷(EPQ)。在數(shù)據(jù)收集后使用統(tǒng)計(jì)學(xué)方法對(duì)數(shù)據(jù)進(jìn)行處理,主要方法有信效度檢驗(yàn)、描述性統(tǒng)計(jì)方法(頻數(shù)、百分比或均數(shù)±標(biāo)準(zhǔn)差)、t檢驗(yàn)、另外為了解出院意愿的相關(guān)影響因素,還采用多元LOGISTIC回歸技術(shù)來對(duì)數(shù)據(jù)進(jìn)行分析。 結(jié)果(1)醫(yī)保創(chuàng)傷患者SCL-90各因子分和總均分均高于普通人群,除軀體化、人際關(guān)系敏感、偏執(zhí)與精神病性外,都有顯著差異(P0.05),而不同出院意愿患者的差異出現(xiàn)在抑郁和焦慮的水平上(P0.05)。受測者自尊水平低于國內(nèi)常模,但與出院意愿之間無相關(guān)性；社交回避與焦慮及人格方面相較于普通人群無差異性,與不同的出院意愿比較結(jié)果也未見差異性。醫(yī)保創(chuàng)傷患者在PTSD癥狀分布上,主觀評(píng)價(jià)創(chuàng)傷對(duì)精神的打擊出現(xiàn)的幾率最高,達(dá)到45.59%,其次為心悸、出汗、胸悶等不適,占43.38%,分布最低的為煩躁不安,占13.97%；回避癥狀方面,悲觀失望比例最高,占33.09%,變得與信任感情疏遠(yuǎn)最低,占8.82%；警覺性增高方面,看到或聽到與創(chuàng)傷有關(guān)的事情擔(dān)心再度受傷比例最高,占32.35%,睡眠障礙最低,古8.09%；社會(huì)功能受損上,自覺學(xué)習(xí)或工作受影響占46.32%,感到內(nèi)疚或有罪感僅古6.62%。不同出院意愿在PTSD-SS的量表總分、對(duì)創(chuàng)傷事件的主觀評(píng)定和反復(fù)重現(xiàn)體驗(yàn)等多個(gè)維度上存在差異(P0.05)。(2)不同出院意愿的患者,其年齡、受學(xué)校教育年限、醫(yī)保情況、創(chuàng)傷類型、住院天數(shù)(費(fèi)用)、治療效果存在著差異性(P0.05),而與性別、婚姻狀況、工作狀態(tài)未見統(tǒng)計(jì)學(xué)差異(P0.05)。(3)工傷與非工傷醫(yī)保患者心理狀況除SCL-90部分維度及PTSD的水平外(P0.05),其他量表的水平差異未見統(tǒng)計(jì)學(xué)意義(P0.05)；工傷醫(yī)保患者相較于其他其他類型醫(yī)保在職人數(shù)比例高、住院時(shí)長及次數(shù)較多、出院意愿較低。 結(jié)論患者的心理健康程度會(huì)影響其出院意愿,為保障衛(wèi)生服務(wù)的合理應(yīng)用應(yīng)當(dāng)通過多種方式,如加強(qiáng)健康教育與心理干預(yù),調(diào)整治療方案,改善治療措施等來矯正患者的不正常住院服務(wù)利用行為。
[Abstract]:Objective to explore the psychological status of patients with trauma in medical insurance, and analyze the factors influencing their willingness to leave the hospital, so as to provide relevant theoretical support for improving patients' compliance to discharge and reducing the over-utilization of health services, so as to reduce the waste of excessive health resources. Better improve health care for all. Methods first of all, extensive literature retrieval and detailed reading were carried out according to the subject and contents of the study. Through literature combing and data collation, there is a preliminary understanding of the existing trauma patients' mental health and patients' willingness to leave the hospital, and a general description is carried out at the same time, in addition to the conceptual and theoretical carding. It also pays attention to the method of empirical investigation. By adopting structural questionnaire and observation method, 136 trauma patients in the Department of surgery of Xiangya third Hospital and Hunan Boai Rehabilitation Hospital of Hunan Xiangya University were investigated and qualitative interviews were conducted to collect information and data. The questionnaire included basic data, mental health self-rating scale (SCL-90), self esteem scale (SES), social avoidance and anxiety scale (SADX), Eysenck Personality questionnaire (EPQ). After data collection, the data were processed by statistical method, and the main methods were reliability and validity test. Descriptive statistical method (frequency, percentage or mean 鹵standard deviation) was used to analyze the data. In order to understand the related factors of discharge intention, multivariate LOGISTIC regression technique was used to analyze the data. Results 1) the scores of SCL-90 factors and total mean scores in patients with trauma in medical insurance were higher than those in the general population, except somatization, sensitivity of interpersonal relationship, paranoid ideation and psychosis. There were significant differences (P 0.05) between the patients with different discharge intention and depression and anxiety. The self-esteem level of the subjects was lower than that of the Chinese norm, but there was no correlation between the self-esteem level and the discharge intention. There was no difference in social avoidance, anxiety and personality, and there was no difference between social avoidance, anxiety and personality, and there was no difference between social avoidance, anxiety and personality, and there was no difference between social avoidance, anxiety and personality, and there was no difference between social avoidance, anxiety and personality, and there was no difference between social avoidance, anxiety and personality. Up to 45.59, followed by palpitations, sweating, chest tightness and other discomfort, accounting for 43.38 points, the lowest distributed being fidgety, accounting for 13.97; in the aspect of avoidance symptoms, the proportion of pessimism and disappointment is the highest, accounting for 33.09, becoming the least alienated from trust and feeling, accounting for 8.82; and the aspect of increased alertness, Seeing or hearing things related to trauma is the highest proportion of people worried about re-injury, accounting for 32.35%, sleep disorder is the lowest, ancient 8.09; social function is damaged, Conscious study or work was affected in 46.32 patients who felt guilty or guilty only 6.62.There were differences in the total score of PTSD-SS scale, subjective assessment of traumatic events and repeated recurrence experience in different discharge intentions. Their age, school years, medical care, trauma type, hospitalization days (cost, treatment effect) were different (P 0.05), while with sex, marital status, There was no statistical difference in work status (P0.05N. 3) except for the SCL-90 dimension and the level of PTSD, there was no significant difference in the level of other scales between the work-related injury patients and the non-work-related insurance patients (P0.05P 0.05), and there was no significant difference in the level of other scales between the work-related injury patients and the non-work-related injury insurance patients compared with other categories. The number of people in employment is high, The length and frequency of hospitalization were more, and the intention of discharge was lower. Conclusion the mental health of patients will affect their willingness to discharge from hospital. In order to ensure the rational application of health services, we should strengthen health education and psychological intervention, adjust the treatment plan, Improve the treatment measures to correct the abnormal hospitalization service utilization behavior.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R641

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